Diagnosis?!

[F_C_D_]

Cheers,

I am 25, M, former [pack a day] smoker for 10 years (quit about 2 months ago); could use some help/opinions:

SYMPTOMS
I had a dry cough from about mid-Sept., 02, following a 24-hour flu, to about mid-Dec., 02. Did not produce sputum (I can barely produce, but when I try, but comes out clear grayish, with a touch of yellowishness, and thin). Cough was followed by a “tickling” feeling in my throat and proceeded to minor palpitations, chest pains (pressing feeling, tightness, and congestion) and an inability to take a deep breath (but not really shortness of breath).

MEDS
Tried two types of: antibiotics (Amoxocillin & Biaxin), inhalers (Albuterol & Azmacourt), and cough expectorants. Also, using Nasacourt (and will soon start on Clarinex and Postonoid).

TESTS
EKG was done 3 times, no problems.
PPD came up positive recently.
Chest X-ray also revealed no problems.
Peak meter flow about 550 (although as high as 650 and as low as 450).
PFT fine, although told I could have put in more effort.
Methacholine coming soon.

RELIEF
Throat irritation comes like clockwork at night or in dampness.
Symptoms slightly improved by albuterol and expectorant and vastly improved by steroid inhaler for about 2-3 weeks, but returned.
Also, drinking hot tea, eating hot soup, taking a hot shower and using heating pads on the chest all seem to help, to varying degrees (why the common “hot” theme?).

ERRATA
History of heartburn, which was at its worst when cough began; heartburn has almost gone away completely recently.
No known allergies.
No pollutants at work.

Thanks in advance,
FCD!

[National Jewish]

This is not an easy question.  The only other area where you could be having the problem is from the sinuses.  Sinus inflammation, either directly due to an infection or not, can produce much of what you have described.  Without obvious wheezing and no real difficulty breathing with activity or during the night, it is doubtful that this is asthma.  Sinusitis can follow an infection and give these upper airway symptoms.  The smoking history also can complicate the picture.  With or without the methacholine challenge, I would suggest a sinus CT scan.

[starion]

Have you ever been evaluated for GERD or gastric reflux?  Allergies & Post Nasal Drip?  Those are frequent causes of coughing & can occur separately or together.  You can find out more about GERD at www.NationalJewish.org/MedFacts/reflux.html.  You can find out more about allergies and post nasal drip at www.NationalJewish.org, particularly their MedFacts and Understanding series.  Many folks who cough at night particularly have allergies to dust mites which live in their bedding.  Minimizing your exposure to dust mite allergen might improve your symptoms without further testing--see the MedFacts on allergies for suggestions.

Aloha,
Starion

[F_C_D_]

Hi Starion,

Thanks for your reply.

To follow up, yes, I am taking Nasacort for post-nasal drip and the Clarinex and Postonoid I will start on, after seeing if Nasacort brings me relief, are for allergies and GERD, so soon I'll find out if that's the cause.

We'll see, hopefully it's just a case of anxiety....